Burden and associated factors for caregivers of the elderly in a developing country.

The elderly population in South Asia is growing. In Pakistan trained caregivers are scarce and culturally not acceptable. This study assessed the level of stress experienced by caregivers of the elderly and determined the association of care giving burden with different characteristics of the elderly. A cross-sectional, questionnaire based study was conducted using nonprobability purposive sampling. All consenting participants aged 60 years and above needing help with at least one activity of daily living or two instrumental activities of daily living were included. 350 participants were assessed for perceived care giver burden. Care providers were mostly female (68.9%). Half (50.3%) of the caregivers had a positive score on a perceived care burden scale. Financial impact had a strong correlation (0.79) with perceived caregiver burden. Higher dependency levels of a physical and cognitive nature posed greater burden on caregivers. Behavioural issues of the elderly such as verbal abuse and difficulty sleeping were predictors of a higher caregiver burden. Caregiver burden is a significant issue for those caring for elderly family members in Karachi, Pakistan.

General practitioners' awareness and management of common psychiatric disorders: a community-based survey from Karachi, Pakistan.

This study assessed the knowledge and management of common psychiatric disorders by general practitioners (GPs) in Karachi, Pakistan. Structured interviews were carried out in 2009 with 360 GPs selected by cluster random sampling. Patients with psychiatric disorders were estimated to be up to 10% of the daily caseload according to 71.8% of doctors. Two-thirds of GPs were unaware of the ICD-10 diagnostic criteria for depression and anxiety disorders. Benzodiazepines were the most recognized category of medication (75.3%) and were the most commonly used medication for all mental health conditions. Fewer GPs were familiar with selective serotonin reuptake inhibitors (35.1%) or tricyclic antidepressants (20.2%). Lack of time and patients' financial constraints were reported to be barriers to care. Most GPs (69.2%) had not received any recent medical education about mental health problems. Gaps in GPs' knowledge about the management of mental disorders have implications for the rational use of psychotropic medications in primary care.

Integration of geriatrics into a spiral undergraduate medical curriculum in Pakistan: evaluation and feedback of third-year medical students.

BACKGROUND: In the last decades there has been a sharp rise in the elderly population throughout the world. The unique needs of the elderly require a multidisciplinary and comprehensive medical approach. None of the 50 medical schools in Pakistan teach geriatrics in their undergraduate or postgraduate training. This paper discusses the development and implementation of the first geriatric curriculum in a medical school of Pakistan and its effect on knowledge and attitudes of third-year medical students. METHODS: The curriculum was designed through collaboration and approval of various academic departments at the Aga Khan University in Karachi Pakistan. After a review of existing geriatric curricula at other institutions, a problem-based, inter-disciplinary spiral curriculum was designed. Strategy of student and course evaluation was planned and incorporated in the curricular program. No extra resources or funds were used. A component of the new curriculum was assessed by evaluating pre- and post- course knowledge, and seeking feedback from participating third-year students. RESULTS: A significant improvement in mean scores for summed overall knowledge in geriatrics (pre-test mean 4.7 vs. post-test mean 6.4, p value of <0.001; out of a maximum possible of 9 was noted. Breakdown of knowledge mean scores into component areas of knowledge showed a significant increase in understanding in aging demographics (pretest 0.7 vs. post-test 1.7, p value of <0.001), geriatric history taking (pretest 0.64 vs. post-test 0.88, p 0.001) and geriatric assessments (pre- test 1.4 vs. post- test 1.7, p value 0.01). A strong majority (87%) of the students felt that the overall course objectives were achieved. All students were satisfied with the quality of teaching, 90% rating it good or higher. CONCLUSION: An important advance in medical education was achieved via integration of a low cost, spiral geriatrics curriculum in a medical university of Pakistan. We found that introduction of the geriatric curriculum improved the knowledge of third-year medical students. This was our school's initial step towards building professional capacity in response to a rising elderly population.

Burden and associated factors for caregivers of the elderly in a developing country

The elderly population in South Asia is growing. In Pakistan trained caregivers are scarce and culturally not acceptable. This study assessed the level of stress experienced by caregivers of the elderly and determined the association of care giving burden with different characteristics of the elderly. A cross-sectional, questionnaire based study was conducted using nonprobability purposive sampling. All consenting participants aged 60 years and above needing help with at least one activity of daily living or two instrumental activities of daily living were included. 350 participants were assessed for perceived care giver burden. Care providers were mostly female [68.9%]. Half [50.3%] of the caregivers had a positive score on a perceived care burden scale. Financial impact had a strong correlation [0.79] with perceived caregiver burden. Higher dependency levels of a physical and cognitive nature posed greater burden on caregivers. Behavioural issues of the elderly such as verbal abuse and difficulty sleeping were predictors of a higher caregiver burden. Caregiver burden is a significant issue for those caring for elderly family members in Karachi, Pakistan

La population âgée d'Asie du Sud-Est connaît une augmentation. Au Pakistan, les personnels soignants formés sont rares et non acceptés d'un point de vue culturel. La présente étude avait pour objectif d'évaluer le niveau de stress des aidants de personnes âgées et de déterminer l'association entre le fardeau de soins et différentes caractéristiques propres aux personnes âgées. Une étude transversale, reposant sur un questionnaire, a été conduite en recourant à un échantillonnage non probabiliste par choix raisonné. Toutes les personnes consentantes âgées de 60 ans et plus requérant une aide pour au moins une activité de la vie quotidienne ou deux activités instrumentales de la vie quotidienne ont été incluses. Le fardeau perçu par les aidants a été évalué chez 350 participants. Les dispensateurs de soins étaient majoritairement des femmes [68,9%]. La moitié [50,3%] des aidants obtenaient des scores élevés sur l'échelle d'évaluation du fardeau de soins. L'impact financier avait une forte corrélation [0,79] avec la perception du fardeau de soins. Des niveaux de dépendance physique ou cognitive plus élevés rajoutaient au fardeau supporté par les aidants. Les problèmes comportementaux des personnes âgées tels que des insultes verbales ou des troubles du sommeil constituaient d'importants indicateurs d'un fardeau plus lourd. Le fardeau des aidants est un problème de taille pour les personnes qui prennent soin de membres âgés de leurs familles à Karachi, au Pakistan

General practitioners' awareness and management of common psychiatric disorders: a community-based survey from Karachi, Pakistan

This study assessed the knowledge and management of common psychiatric disorders by general practitioners [GPs] in Karachi, Pakistan, Structured interviews were carried out in 2009 with 360 GPs selected by cluster random sampling. Patients with psychiatric disorders were estimated to be up to 10% of the daily caseload according to 71.8% of doctors. Two-thirds of GPs were unaware of the ICD-10 diagnostic criteria for depression and anxiety disorders. Benzodiazepines were the most recognized category of medication [75.3%] and were the most commonly used medication for all mental health conditions. Fewer GPs were familiar with selective serotonin reuptake inhibitors [35.1%] or tricyclic antidepressants [20.2%]. Lack of time and patients financial constraints were reported to be barriers to care. Most GPs [69.2%] had not received any recent medical education about mental health problems. Gaps in GPs' knowledge about the management of mental disorders have implications for the rational use of psychotropic medications in primary care